Attorney's Textbook Of Medicine: Manual Of Traumatic Injuries, Set
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Young (2006) observed that psychological first aid is indicated when an individual has an acute stress reaction in response to trauma (e.g., dissociative symptoms, extreme anxiety, a high level of cognitive impairment) or is at high risk for a traumatic stress reaction. The NCTSN and the NCPTSD (2006) created a manual, now in its second edition, that provides further guidelines for providing psychological first aid (available at -first-aid). These guidelines have been widely accepted and adopted by organizations such as the American Red Cross (Kantor & Beckett, 2011).
Another promising innovation in the delivery of ET is narrative ET, which was originally developed for use in countries with less economic development but has since been used in more developed nations (Robjant & Fazel, 2010). This approach was designed to be delivered by individuals who are not mental health professionals and to require a relatively short treatment time; it was also intended to document atrocities as well as treat PTSD. It is a manualized approach and involves emotional exposure to memories of trauma that takes place in the context of creating a narrative about the traumatic event. Robjant and Fazel (2010) reviewed findings from six trials involving the treatment of both children and adults that were conducted in countries with low to medium economic development and four conducted in countries with high economic development (although typically with refugee populations). These studies found that participation in the intervention was associated with reductions in PTSD symptoms and, in some cases, with reductions in other mental disorder symptoms and improvements in overall psychological well-being. Studies found greater improvements in outcomes among those receiving the intervention compared with no treatment, treatment as usual, psychoeducation, interpersonal therapy, or supportive counseling.
Section 8(c)(2) of the OSH Act directs the Secretary to issue regulations requiring employers to record "work-related" injuries and illnesses. It is implicit in this wording that there must be a causal connection between the employment and the injury or illness before the case is recordable. For most types of industrial accidents involving traumatic injuries, such as amputations, fractures, burns and electrocutions, a causal connection is easily determined because the injury arises from forces, equipment, activities, or conditions inherent in the employment environment. Thus, there is general agreement that when an employee is struck by or caught in moving machinery, or is crushed in a construction cave-in, the case is work-related. It is also accepted that a variety of illnesses are associated with exposure to toxic substances, such as lead and cadmium, used in industrial processes. Accordingly, there is little question that cases of lead or cadmium poisoning are work-related if the employee is exposed to these substances at work.
OSHA should eliminate its proposed recording requirements for mental illness. OSHA's proposed rule includes changes in an employee's psychological condition as an "injury or illness," and [proposed] Appendix A presumes that mental illness "associated with post-traumatic stress" is work related. Employers, employees, and OSHA have been wrestling for 25 years with the proper recording of fairly simple injuries like back injuries, sprains, and illnesses caused by chemical exposures. Requiring employers to record something as vague as psychological conditions will impose impossible burdens on employers (and compliance officers) and thus will create an unworkable recordkeeping scheme.
Because the OSHA system is intended to measure the incidence of occupational injury and illness, each individual injury or illness should be recorded only once in the system. However, an employee can experience the same type of injury or illness more than once. For example, if a worker cuts a finger on a machine in March, and is then unfortunate enough to cut the same finger again in October, this worker has clearly experienced two separate occupational injuries, each of which must be evaluated for its recordability. In other cases, this evaluation is not as simple. For example, a worker who performs forceful manual handling injures his or her back in 1998, resulting in days away from work, and the case is entered into the records. In 1999 this worker has another episode of severe work-related back pain and must once again take time off for treatment and recuperation. The question is whether or not the new symptoms, back pain, are continuing symptoms of the old injury, or whether they represent a new injury that should be evaluated for its recordability as a new case. The answer in this case lies in an analysis of whether or not the injured or ill worker has recovered fully between episodes, and whether or not the back pain is the result of a second event or exposure in the workplace, e.g., continued manual handling. If the worker has not fully recovered and no new event or exposure has occurred in the workplace, the case is considered a continuation of the previous injury or illness and is not recordable. 2b1af7f3a8